What killed Niccolo Paganini? You name the disease and Paganini had it: syphilis, Marfan's Syndrome, Ehlers-Danlos Syndrome, and then there were general problems such as tuberculosis, malnutrition, colitis, cancer, dental, visual, urological - the list is endless. Did these have any bearing on the musical genius of Paganini? Let us be quite honest. Paganini was a true dichotomy. One pillar of his fame rests firmly on incredible musical genius. This will surely endure. So will that equally brilliant pillar of fame - his ability to promote himself... often in the most blatant manner. As they say, there is no bad publicity. So, where does his genius leave off and hucksterism begin?

Paganini was many things all rolled into one. Was he "The Greatest Violinist of All Time?" I believe he was! Certainly, he was the greatest creative genius of the violin. Quite parallel to this were his formulas for garnering publicity. These have served all ensuing generations, from Franz Liszt, through Frank Sinatra, Elvis Presley, The Beatles, and into our own day with Michael Jackson and Madonna (just to mention a few). Unlike those talents created solely by publicity (naturally excluding Liszt), Paganini could arouse the public interest by just walking down the street!

Carl Guhr was the one who revealed Paganini's technical genius to the world in his 1829 book, "Paganini's Art of Violin Playing."
Guhr wrote a most revelatory passage: "The public is not content to declare Paganini the paramount artist. No, they try to put him into conflict with himself, perhaps because of his pathological countenance. A famous physician almost ruined his health with improper treatments. This decayed his already weak body and then the removal of a tooth resulted in the loss of all the teeth of the lower jaw.."

Let us see if we can reconcile the musical genius of Paganini with his pathology. Very early on, Paganini arrived at a hitherto unknown level of virtuosity. The newly discovered "Inno Patriottico" (critical edition by Fabrizio Ammetto) dating from the end of the 18th century clearly demonstrates his technical discoveries. Quoting Ammetoo: "We therefore find: high positions, double stops, single and double harmonics, 'al ponticello' effects, and fast arpeggios..." here, also, marks the introduction of the large stretch of the 10th. For an in depth analysis of the technical innovations, the reader is urged to read "Paganini's Art of Violin Playing" by Carl Guhr (1829).

The fortuitous discovery of Paganini's death-cast hand allows us to examine his techniques via an analysis of his hand. Briefly mentioned here are those ailments which do not bear directly on the technique of the violin. The last few years of Paganini's life were marked by the inability to talk. This was due to the diagnosis of tuberculosis of the larynx. Some sources credit his death to this. That he was pathologically thin, could be related to his omnipresent digestive problems. He was also addicted to purgatives. However, a valuable medical observation was: "He is thin because it is his nature to be thin."

There has been much discussion as to whether Paganini had Marfan's Syndrome, and if it had any effect on his technique. Briefly stated, Marfan's Syndrome is a disease of the connective tissue. There are many concomitant diseases, and the difference between them is minimal. For our musical purposes, the characteristics of these diseases aree abnormal flexibility of the joints. This flexibility exceeds what is referred to as "hyper flexibility." In advanced cases of Marfan's, the individual can actually dislocate his own joints, and then pop them back in place. Now, we know that the genius of Paganini created hitherto unknown technical effects on the violin. Many of these innovations include wide stretches of the fingers of the left hand, rapid position changes, and lively bowings. Certainly, the abnormal flexibility of Marfan's would allow for what Guhr called "Paganini's Tours de Force." These include long passages in tenths, his famous huge stretches of the left hand, quick jumps all over the fingerboard, trills in unison on two strings, solos in high positions up and down the G string, and the large stretches required in playing double harmonics. Whether Paganini actually used fingered octaves is debatable. One of Paganini's most extraordinarily ostentatious displays was to play four octaves of E flat simultaneously across the fingerboard, and then descend in parallel octaves to D and C. Sometimes he might go even lower. The fabled four octaves of A flat was actually accomplished with scordatura tuning, however. He would do these tricks as a warm-up prelude to the actual music. Another staged exercise was to fully extend his right arm in a large circle before putting the bow on the string. This type of musing on stage was not unique. The famous pianist Josef Hofmann (1876-1957) can be heard doing his own version of "getting in the mood" in recordings of his live concerts. Paganini, showman that he was, created nearly as much interest in these shenanigans as with his masterpieces. If the maestro did have Marfan's, it would have had more effect on his left hand technique than the right. The right hand is required to stretch and contract, twist, and do acrobatic jumps. By comparison, the right hand is more passive. In reality, the techniques of right hand technique greatly exceed the techniques of the left hand, but they are more subtle. Because most players are right handed, this is why the bow is entrusted to the right hand.

A discussion of the connection between Marfan's syndrome (and its allied diseases) and syphilis is germane here. Furthermore, the problems of poor vision and his dental disasters are interrelated and bear mentioning. That Paganini was treated for syphilis is universally known. The usual remedy was "the notorious mercury treatment." Arriving early at an active sexual maturity, Paganini acquired syphilis. The treatment resulted in those many problems of which he constantly complained. But did he actually have syphilis? This is a most perplexing question.

The noted physician Dr. Ephraim Engleman is a wealth of information in this regard. Since he is a famous medical doctor and at the same time a fine violinist and noted violin collector, I showed him the death-cast hand and all the evidence. The first question to answer is how the syphilis was diagnosed. If it was diagnosed because of the syphilitic chancre, then there is no doubt. However, the chancre is painless. If the diagnosis was made during an examination of the hearth through the stethoscope there is another possibility. This is the possibility of Marfan's Syndrome or its relative Ehlers-Danlos Syndrome. The difference between these is really and academic exercise.

The death-cast hand is of the right hand, and cast in bronze. Because of the curious position, bent at the wrist, we think the hand rested on a pillow in death. Looking at the hand we are rather impressed with the length of the digits. It is not possible to see the hyper flexibility here, but one can see it in various drawings by Peter Lyser (1803-1870). These drawings show extraordinary flexibility of the left hand. Another characteristic of these diseases is that the skin is loose. This is to be seen both in the life-cast hand as well as the death-cast hand. The fingers are not straight. The digit drops at the knuckle. There is pronounced contracture of the ring finger. This, along with the general impression of the knuckles, might indicate osteoarthritis. Nonetheless, it is a fixed deformity. If the left hand suffered similarly, it would certainly have hampered any concert activity.

Most distressing is the state of muscular atrophy. This can be noted in the emaciation of the dorsum (top of the hand), and the muscles at the base of the thumb, and at the base of the fourth finger. Space prevents a more complete physical analysis. Guhr urged his readers "not to view Paganini as a demon from dark regions where mortals fear to tread." This admonition is as valid as it was in 1829.

A second opinion by genetics expert, Dr. Charles J. Epstein, confirmed five things:

1) There are many fascinating medical reports by noted experts in the field. Articles by Richard D. Smith with John W. Worthington (JAMA March 1967), Myron R. Schoenfeld (JAMA January 1978), and the renowned Victor A. McKusick are worth reading but inconclusive. One article, quite outlandish from the Italian newspaper "Corriere della Sera," links Paganini and international terrorist Osama Bin Laden.

2) The fingers are long allowing for atrophy, the hand and fingers are slender. Measurements of the palm at 8.5 cm and the middle finger at 7.5 cm confirm this. These measurements are approximate because the hand and fingers are bent, and there are depressions in the palm. Nonetheless, the finger to palm ratio is about 0.47 and places the hand above the 97th percentile. Objectively speaking, the fingers are long relative to the palm. Possibly this is a manifestation of Marfans.

3) The drawings by Lyser, of Paganini's left hand, graphically portray great flexibility.

4) There is much speculation.

5) An examination of the corpse could offer something more conclusive.

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